title: Epidemiology, species distribution, antifungal susceptibility, and outcome of candidemia across five sites in Italy and Spain.
abstract: Candidemia has become an important bloodstream infection that is frequently associated with high rates of mortality and morbidity, and its growing incidence is related to complex medical and surgical procedures. We conducted a multicenter study in five tertiary care teaching hospitals in Italy and Spain and evaluated the epidemiology, species distribution, antifungal susceptibilities, and outcomes of candidemia episodes. In the period of 2008 to 2010, 995 episodes of candidemia were identified in these hospitals. The overall incidence of candidemia was 1.55 cases per 1,000 admissions and remained stable during the 3-year analysis. Candida albicans was the leading agent of infection (58.4%), followed by Candida parapsilosis complex (19.5%), Candida tropicalis (9.3%), and Candida glabrata (8.3%). The majority of the candidemia episodes were found in the internal medicine department (49.6%), followed by the surgical ward, the intensive care unit (ICU), and the hemato-oncology ward. Out of 955 patients who were eligible for evaluation, 381 (39.9%) died within 30 days from the onset of candidemia. Important differences in the 30-day mortality rates were noted between institutions: the lowest mortality rate was in the Barcelona hospital, and the highest rate was in the Udine hospital (33.6% versus 51%, respectively; P = 0.0005). Overall, 5.1% of the 955 isolates tested were resistant or susceptible dose dependent (SDD) to fluconazole, with minor differences between the hospitals in Italy and Spain (5.7% versus 3.5%, respectively; P = 0.2). Higher MICs for caspofungin were found, especially with C. parapsilosis complex (MIC90, 1 μg/ml). Amphotericin B had the lowest MICs. This report shows that candidemia is a significant source of morbidity in Europe, causing a substantial burden of disease and mortality.
authors.affiliation: Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Bassetti
authors.forename: Maria
authors.initials: M
authors.lastname: Merelli
authors.forename: Elda
authors.initials: E
authors.lastname: Righi
authors.forename: Ana
authors.initials: A
authors.lastname: Diaz-Martin
authors.forename: Eva Maria
authors.initials: EM
authors.lastname: Rosello
authors.forename: Roberto
authors.initials: R
authors.lastname: Luzzati
authors.forename: Anna
authors.initials: A
authors.lastname: Parra
authors.forename: Enrico Maria
authors.initials: EM
authors.lastname: Trecarichi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Sanguinetti
authors.forename: Brunella
authors.initials: B
authors.lastname: Posteraro
authors.forename: Jose
authors.initials: J
authors.lastname: Garnacho-Montero
authors.forename: Assunta
authors.initials: A
authors.lastname: Sartor
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
authors.forename: Mario
authors.initials: M
authors.lastname: Tumbarello
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000494:pharmacology*; D002175:Candida / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification*; D058387:Candidemia / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis; D062606:Tertiary Care Centers; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents